Comparison of General Surgical Practice Size and Setting in 2017 vs 2013 in the US

Tsai, Thomas C.; Jacobson, Benjamin; Benjamin, Evan M.; Figueroa, José F.

doi:10.1001/jamanetworkopen.2021.6848

Cited by 6 publications

(15 citation statements)

References 22 publications

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“…Other studies have documented fewer surgeons in the specialty and general surgical workforce in rural areas 3–7,21,22 . Multiple factors contribute, including the aging and retirement of the rural workforce, rural hospital closures, regionalization of complex procedures to larger centers, or surgeon preference on where to live 6,23–29 . Our data demonstrate that the changes in the rural‐urban maldistribution over time were specialty dependent.…”

Section: Discussionmentioning

confidence: 52%

“…[3][4][5][6][7]21,22 Multiple factors contribute, including the aging and retirement of the rural workforce, rural hospital closures, regionalization of complex procedures to larger centers, or surgeon preference on where to live. 6,[23][24][25][26][27][28][29] Our data demonstrate that the changes in the rural-urban maldistribution over time were specialty dependent. General and colorectal surgeons have a significantly widening rural-urban disparity in physician density, although absolute changes were small.…”

Section: Discussionmentioning

confidence: 94%

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Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

Herb

Holmes

Stitzenberg

2022

The Journal of Rural Health

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Purpose We evaluated temporal trends in rural‐urban disparities of the surgeon supply among surgeons commonly treating patients with cancer. Methods We performed a retrospective observational study of county‐level workforce changes from 2004 to 2017 using the Area Health Resource File. We calculated physician density (providers/100,000 population) for each specialty by rural and urban counties using the 2003 Rural‐Urban Commuting Codes (RUCC), and evaluated percent changes in the rural‐urban disparity in physician density. Secondary analyses evaluated these changes by Census region. Additionally, Gini indices were calculated by year and RUCC to evaluate the workforce inequality within rural areas. Findings Total surgical specialist density declined in rural areas from 16 to 14 per 100,000 population, and declined slightly from 33 to 31 per 100,000 population in urban areas, for a rural‐urban disparity increase of 8% (95% CI 5%,10%). Among specific specialties, the percentage increase in the rural‐urban workforce supply disparity was largest for colorectal surgeons and general surgeons at 66% (95% CI 51%,80%) and 72% (95% CI 58%,86%), respectively, although absolute changes were small. Regional heterogeneity of the workforce was higher for rural areas than urban areas. Conclusions Changes in the rural‐urban physician workforce disparities over time are dependent upon specialty, region, and local community factors. This highlights how surgical workforce policy should be oriented to the local area circumstances.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 94%

Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

Herb

Holmes

Stitzenberg

2022

The Journal of Rural Health

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“…Previous work has suggested that larger surgical practices are more likely to be affiliated with health systems and be hospital–based, and surgeon–practice level variation in outcomes should be further explored. 17…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Trends in 30-Day Mortality Between Multi-Site and Single-Site Surgeons

et al. 2023

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Background: Quality leaders are concerned that creation of multi-hospital health systems may lead to surgeons traveling to and from distant hospitals and thus to more fragmented surgical care and worse outcomes for their patients. Despite this concern, little empirical data exist on outcomes of multi-site versus single-site surgeons. Methods: Using national Medicare data, we assessed trends in the number of multi-site vs. single-site surgeons from 2011 to 2016. We performed a multivariable regression analysis to compare overall 30-day mortality differences, stratified by system and rural status, and examined trends over time. Results: The number of multi-site surgeons and the percentage of multi-site surgeons per hospital decreased over time (24.2%–19.0%; 44.3%–41.8%). Overall, multi-site surgeons had lower 30-day mortality than single-site surgeons (2.24% vs 2.50%, P < 0.01). When stratified by system status, multi-site surgeons performed better in-system (2.47% vs 2.58%, P < 0.01); by rural status, multi-site surgeons had lower mortality in non-rural hospitals (2.42% vs 2.51%, P < 0.01). The statistically significant but small mortality advantage of multi-site versus single-site surgeons decreased over time, such that by 2016 there was no difference in outcomes between multi-site and single-site surgeons. Conclusion: For the majority of study years, multi-site surgeons had lower 30-day mortality than single-site surgeons, but this trend narrowed until outcomes were equivalent by 2016. Surgeons operating at multiple hospitals can provide surgical care to patients without any evidence of increased mortality.

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“…

The geographical structure of medical and surgical care delivery is associated with not just access to, but also potentially quality of, care, as suggested in the study by Tsai et al 1 The authors used a novel Medicare database to examine the distribution of general surgeons across billing entities and within hospital referral regions (HRRs) and found a trend toward greater concentration of surgeons into larger organizations. 1 The structure of markets for general surgery services in the United States has changed over time for many reasons. The uneven changes in population, such as how the South and West have experienced large and rapid regional increases in populations, have created complex, diffuse markets for all medical and surgical services.

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mentioning

confidence: 99%

“…Rural places have generally been left behind by these trends, with their hospitals often closing if not merging and transforming into a different form of organization. 3 Perhaps more importantly, as Tsai et al 1 point out, the organization of general surgical practice has changed as practices have merged into larger and larger structures-another factor that can have implications for the viability of rural hospitals. 4 The use of HRRs for studying medical care delivery markets is seen as almost a criterion standard for the analysis of competition, but the HRRs from the Dartmouth Atlas of Health Care used by Tsai et al 1 and elsewhere in the literature reflect market structures of 2008 and earlier and have other inherent characteristics that may call for caution in interpreting data and trends based on them.…”

mentioning

confidence: 99%

Place and Population Matter in General Surgeon Location and Practice Structure

Ricketts

2021

JAMA Netw Open

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Comparison of General Surgical Practice Size and Setting in 2017 vs 2013 in the US

Cited by 6 publications

References 22 publications

Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

Longitudinal Trends in 30-Day Mortality Between Multi-Site and Single-Site Surgeons

Place and Population Matter in General Surgeon Location and Practice Structure

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